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Cardiac Surgeon Uses Matrox Monarch HDX H.264 Encoder to Record and Stream Surgical Procedures

Dr. Sarju Ralhan and his surgical team at Hero DMC Heart Institute in Ludhiana, India are promoting a new surgical method using a streaming and recording workflow built around the Monarch HDX

Dr. Sarju Ralhan is breaking new ground at the Hero DMC Heart Institute in Ludhiana, India. An internationally acclaimed surgeon with a focus in cardiovascular, thoracic and vascular surgery, he has a keen interest in the surgical management of patients afflicted with coronary artery disease and diseases of the aorta.

Having done more than 5,000 off-pump coronary artery bypass grafting (OPCABG) procedures, Dr. Ralhan’s specialty is total arterial grafting on a beating heart using bilateral internal thoracic arteries (ITA), the arteries that provide an important alternate blood supply if the native coronary arteries become obstructed. He performs the surgery using the rare procedure of just one incision to the chest. According to Dr. Ralhan, this method extends the surgery by 20 minutes but can add 20 years to the patient’s life expectancy.

Promoting the Procedure

Intent on promoting this new surgical method, Dr. Ralhan wanted to find an effective way to reach the public in general and specialized surgeons in particular. Given the busy schedules of his team and other healthcare professionals, watching the surgery live in the operating room was not always practical. Dr. Ralhan wanted a device that could record the procedures and provide straightforward access to the videos. To achieve this, he required high quality video delivery, recording capabilities, portability and ease of use.

Dr. Ralhan and his team evaluated many video capture devices but narrowed their search to the Matrox Monarch HDX, an H.264 dual-channel recording and streaming appliance, after consulting product reviews and a local distributor (Figure 1, below).


Figure 1. The Matrox Monarch HDX H.264 dual-channel recording and streaming appliance. Click the image to see it at full size.

A Surgical Solution

Using Monarch HDX, the workflow is very straightforward. Surgeries are filmed with a Luxtec headlight camera or a Nikon D810 camera. The Luxtec headlight camera outputs composite video which goes through a composite-to-SDI converter then into the Monarch HDX encoder. The Nikon D810 outputs an HDMI signal which goes directly to the Monarch HDX.

To stream the surgery, Monarch HDX sends an RTSP stream over the LAN at 2 Mbps. Dr. Ralhan’s staff can view the live stream directly from computers on the LAN or via Wi-Fi on their mobiles or tablets, all using VLC Player.

To record the surgery, the Monarch HDX is typically set to record at 25 Mbps to a USB drive or SD card. Monarch HDX provides the option to save files to a variety of recording media types, including a shared network drive, USB drive or SD card; so it is easy to store recordings in a way that works for everyone. The videos are reviewed and edited with Final Cut Pro X or Adobe Premiere before being made available to medical professionals on Dr. Ralhan’s YouTube channel and website. The surgical recordings are also provided to patients on a thumb drive.

Monarch HDX profiles simplified setup. Technicians use the Monarch HDX Command Center to initially select resolution, bitrate, and all other streaming and/or recording parameters then to save a profile. In advance of a surgery, any operator can easily choose one of the pre-configured profiles for a particular camera or destination, for example, and the parameters will be loaded automatically.

Technicians also take advantage of Monarch HDX’s H.264 preview stream feature to view a low bitrate preview of the input directly in the Command Center before going live (Figure 2, below).

Figure 2. Matrox Monarch HDX’s H.264 preview stream feature lets Dr. Ralhan verify the input before beginning his live webcasts. Click the image to see it at full size.

The Final Result

Since implementing the Monarch HDX into his workflow, Dr. Ralhan has found that “this content delivery mechanism is quite easy and user friendly, and adds no additional cost.” Viewers simply need to log in and open a VLC player on their device of choice to watch the latest surgeries in HD.

Expanding the Scope

Dr. Ralhan intends to use Monarch HDX to live-stream surgeries to surgeons around the world. He hopes to have his surgeries featured on websites such as with the goal of getting young surgeons to use this technique more frequently. “As of today, only my operating room staff members view the live streams, but I expect to live stream surgeries for workshops where I will have a broader audience.”

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